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Cognitive-Behavior Therapy

What is Cognitive-Behavior Therapy?

Cognitive therapy, also know as cognitive-behavior therapy, is a uniquely effective treatment for both anxiety disorders and depression.  It is also highly effective for sexual dysfunctions and some eating disorders and can be beneficial for anyone who wants to improve their sense of emotional well-being. It is clearly the treatment of choice for anxiety disorders with numerous treatment outcome studies showing it to provide the greatest improvement with the most lasting results. In many ways cognitive-behavior therapy is an educative approach, where the therapist takes an active role. Most people can be helped with short-term therapy, usually from 5-15 sessions, while some people may require longer therapy.
Cognitive-behavior therapy combines two great therapeutic traditions those of cognitive therapy and behavior therapy.

Cognitive therapy, developed by Aaron Beck M.D., focuses on changing dysfunctional thinking patterns and is based on the fact that there is a very close relationship between emotional distress and irrational thinking. Each negative emotional state has a specific pattern of distorted thinking which tends to perpetuate it. For example, when people have panic attacks they typically have thoughts such as:
  • "What if I go crazy or lose control?"
  • "What if I have a heart attack or stop breathing?"
  • "What if I faint?"
When people get depressed they typically have distorted negative thoughts about their self-worth, the world, and the future.

Cognitive therapy teaches you how to recognize and free yourself from such distorted thinking which results in relief from emotional suffering. Cognitive therapy also helps you to give up underlying irrational beliefs such as the idea that you need everyone’s approval or that you should be perfect or should always be in control of things.

Behavior therapy, developed by Joseph Wolpe M.D., sees anxiety disorders as the result of maladaptive anxiety acquired through experience most often by means of conditioning, and it focuses on desensitizing anxiety through corrective learning.  This is most often achieved through exposure therapy which means exposure to the situations that are feared. Exposure therapy is the single most effective treatment for anxiety disorders which very dramatic and lasting results often achieved in a very short time. Behavior therapy also includes such helpful techniques as assertive training, social skills training, and exposure through imagery.

Why Cognitive-Behavior Therapy is Better Than Medication

Many if not most people today are given medication alone for anxiety disorders and for depression. This is clearly not the right treatment, since it usually does not achieve a lasting resolution of the problem. Treatment outcome studies with anxiety disorders clearly show that cognitive-behavior therapy often can lead to a full resolution of the problem and often with short-term therapy. It is clearly the treatment of choice for anxiety disorders.  Whereas the majority of people who take only medication relapse within six months of stopping their medication, the great majority of people do not relapse after cognitive-behavior therapy but rather continue to improve after the therapy ends. Unfortunately many people who might overcome their problem with cognitive-behavior therapy end up taking medications for years or even for life.  With cognitive-behavior therapy the idea is to help people overcome their problem with no further therapy needed, not to keep them indefinitely in treatment. In the case of depression some people do well with medication alone, but this is difficult to judge, since most depressive episodes are time limited and improve even without treatment. Psychiatrist David Burns of Stanford Medical School believes that medication alone is not the best treatment for depression, and he uses either cognitive therapy alone or in combination with medication.

What About A Combined Treatment?

Many people including many psychotherapists believe that a combined treatment of cognitive-behavior therapy and medication is the best treatment. However in the case of anxiety disorders there is no good support for this idea. In fact treatment outcome studies show with all of the anxiety disorders that cognitive-behavior therapy alone gets superior long-term results than a combined treatment. This is likely mostly due to the fact that when people have therapy alone they attribute their improvement to their own efforts which strengthens their confidence and sense of mastery.  If they are also taking medication there is a chance that they may attribute their improvement to the medication which makes them more likely to relapse when they stop taking them. However if you are already taking medication and wish to start cognitive-behavior therapy you can continue taking medication and still fully benefit from the therapy. I never advise people to get off medication but rather tell them that when they feel they have significantly overcome their problem they can discuss tapering off their medication with their physician. The case of depression is not so clear-cut. There are some depressions that do respond best to a combined treatment of cognitive therapy and medication, but unless the depression is severe or you are suffering from bipolar disorder it is probably best to try cognitive-behavior therapy alone first.  In the case of bipolar disorder medication is essential.

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